Percutaneous direct endoscopic pancreatic necrosectomy

Area of Science:

• Gastroenterology
• Surgical Innovation
• Minimally Invasive Procedures

Background:

• Acute necrotizing pancreatitis affects 10%-20% of patients, with infected pancreatic necrosis (IPN) leading to prolonged illness and poor outcomes.
• The standard
• step-up
• approach for IPN involves multidisciplinary, minimally invasive techniques.
• Endoscopic ultrasound-guided transmural drainage is preferred but not always technically possible for all infected fluid collections.

Purpose of the Study:

• To review the indications, techniques, advantages, and disadvantages of percutaneous direct endoscopic necrosectomy (PDEN).
• To highlight PDEN as an adjunct for managing IPN in specific clinical scenarios.
• To present case studies illustrating PDEN in distinct situations.

Main Methods:

• Review of existing literature on PDEN for infected pancreatic necrosis.
• Description of technical advancements in PDEN, including the use of esophageal stents to maintain drainage tracts.
• Presentation of two distinct clinical cases managed with PDEN.

Main Results:

• PDEN is technically feasible and effective in specific cases of IPN where transmural drainage is not possible.
• The use of stents can maintain patency of the drainage tract for repeated endoscopic access.
• PDEN appears safe and effective as an adjunct in expert hands, particularly when a drain is already in place.

Conclusions:

• Percutaneous direct endoscopic necrosectomy (PDEN) is a valuable minimally invasive option for managing infected pancreatic necrosis (IPN).
• PDEN can be particularly useful when conventional endoscopic or percutaneous drainage is not feasible or has failed.
• Further research and case studies support PDEN as an effective adjunct in the treatment of IPN.